HR-2639-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Teresa Leger Fernandez (D-NM)
What it does
This bill would permanently extend two Medicare telehealth flexibilities — originally granted during the COVID-19 public health emergency — specifically for Indian health programs and urban Indian organizations. First, it would allow any location in the United States, including a patient's home, to count as an eligible "originating site" for telehealth visits. Second, it would permanently authorize Medicare coverage and payment for telehealth services delivered via audio-only (phone-only) communications, without requiring video capability, when provided by these programs.
Who benefits
American Indian and Alaska Native Medicare beneficiaries served by Indian Health Service facilities, tribal health programs, and urban Indian organizations — estimated at roughly 600,000 Medicare-eligible individuals. Patients in geographically remote or rural reservation communities who lack reliable broadband or video-capable devices would benefit most from the audio-only provision. Tribal health providers and their employed or contracted physicians and practitioners would gain stable, permanent reimbursement authority. Urban Indian organizations serving off-reservation Native populations would also benefit.
Who is hurt
Non-tribal telehealth providers who remain subject to temporary or more restrictive originating site and audio-only rules may face a competitive or regulatory disparity. Taxpayers and the Medicare Trust Fund would bear any additional costs from expanded coverage. Patients who lack phone access — a small subset even within tribal communities — would not benefit. There are no direct, identifiable groups who lose existing benefits under this bill.
Supporters argue
Supporters argue that American Indian and Alaska Native communities face some of the most severe healthcare access barriers in the country, including geographic isolation, limited broadband infrastructure, and chronic underfunding of the Indian Health Service. They contend that making these flexibilities permanent — rather than subject to repeated temporary extensions — provides the regulatory certainty tribal health programs need to invest in telehealth infrastructure and staffing, and that audio-only access is essential for elderly patients who lack smartphones or reliable internet.
Opponents argue
Opponents argue that permanently carving out tribal programs from standard Medicare telehealth rules — rather than extending improved rules broadly — creates a fragmented, two-tiered reimbursement system that is difficult to administer and may set a precedent for further program-specific exceptions. They contend that audio-only telehealth has documented quality limitations compared to in-person or video visits, and that a permanent exemption without quality benchmarks or outcome monitoring could entrench lower standards of care for a vulnerable population rather than improving access to full-quality services.
Constitutional context
Congress has broad authority to structure Medicare under the Taxing and Spending Clause (Art. I, §8, cl. 1) and the Commerce Clause (Art. I, §8, cl. 3). The bill modifies an existing federal spending program and does not raise the coercion concerns identified in NFIB v. Sebelius (2012), as it imposes no conditions on states. No active constitutional tension is implicated.
Checks and balances
Congress gains permanent statutory authority over these telehealth rules, removing HHS's discretion to modify or end them administratively; HHS retains implementation authority over payment rates and covered service codes, subject to post-Loper Bright independent judicial review.
Historical precedent
The COVID-19 public health emergency (2020–2023) temporarily waived Medicare's originating site and audio-only restrictions nationwide; Congress has repeatedly extended select telehealth flexibilities on a temporary basis through annual appropriations and continuing resolutions since then.